Is an Anterolateral Ligament Reconstruction Required in ACL-Reconstructed Knees With Associated Injury to the Anterolateral Structures? A Robotic Analysis of Rotational Knee Stability

Noyes, Frank R.; Huser, Lauren E.; Jurgensmeier, Darin; Walsh, James; Levy, Martin S.

doi:10.1177/0363546516682233

Cited by 105 publications

(114 citation statements)

References 53 publications

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“…degrees of knee flexion adequately controlled knee kinematics without the need for an additional ALL reconstruction during a simulated pivot shift [38]. However, a residual increase of 5-7 degrees of internal tibial rotation occurs with ALC injury at high flexion angles, which is not controlled by ACL reconstruction.…”

Section: Biomechanics Of Lateralmentioning

confidence: 93%

The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting

Getgood

Brown²,

Lording

et al. 2018

Knee Surg Sports Traumatol Arthrosc

277

280

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The structure and function of the anterolateral complex (ALC) of the knee has created much controversy since the 're-discovery' of the anterolateral ligament (ALL) and its proposed role in aiding control of anterolateral rotatory laxity in the anterior cruciate ligament (ACL) injured knee. A group of surgeons and researchers prominent in the field gathered to produce consensus as to the anatomy and biomechanical properties of the ALC. The evidence for and against utilisation of ALC reconstruction was also discussed, generating a number of consensus statements by following a modified Delphi process. Key points include that the ALC consists of the superficial and deep aspects of the iliotibial tract with its Kaplan fibre attachments on the distal femur, along with the ALL, a capsular structure within the anterolateral capsule. A number of structures attach to the area of the Segond fracture including the capsule-osseous layer of the iliotibial band, the ALL and the anterior arm of the short head of biceps, and hence it is not clear which is responsible for this lesion. The ALC functions to provide anterolateral rotatory stability as a secondary stabiliser to the ACL. Whilst biomechanical studies have shown that these structures play an important role in controlling stability at the time of ACL reconstruction, the optimal surgical procedure has not yet been defined clinically. Concern remains that these procedures may cause constraint of motion, yet no clinical studies have demonstrated an increased risk of osteoarthritis development. Furthermore, clinical evidence is currently lacking to support clear indications for lateral extra-articular procedures as an augmentation to ACL reconstruction. The resulting statements and scientific rationale aim to inform readers on the most current thinking and identify areas of needed basic science and clinical research to help improve patient outcomes following ACL injury and subsequent reconstruction. Level of evidence V.

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Section: Biomechanics Of Lateralmentioning

confidence: 93%

The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting

Getgood

Brown²,

Lording

et al. 2018

Knee Surg Sports Traumatol Arthrosc

277

280

View full text Add to dashboard Cite

show abstract

“…Most injured athletes will undergo ACL reconstruction, but there is an important risk of re-rupture (Paterno et al, 2014;Salmon et al, 2005) and only 65% of patients are able to return to their pre-injury level of sport (Ardern et al, 2014). In order to decrease the risk of a re-rupture, lateral extra-articular reconstruction (LER) is being performed with increasing frequency (Cerciello et al, 2018;Slette et al, 2016), since such a reconstruction is believed to improve the control of knee stability with respect to internal rotation and anterior translation (Inderhaug et al, 2017a(Inderhaug et al, , 2017bKatakura et al, 2017;Noyes et al, 2017;Sonnery-Cottet et al, 2015;Sonnery-Cottet et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Technical considerations in lateral extra-articular reconstruction coupled with anterior cruciate ligament reconstruction: A simulation study evaluating the influence of surgical parameters on control of knee stability

Blache

Dumas

Guise

et al. 2019

Clinical Biomechanics

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Background: Surgical parameters such as the selection of tibial and femoral attachment site, graft tension, and knee flexion angle at the time of fixation may influence the control of knee stability after lateral extra-articular reconstruction. This study aimed to determine how sensitive is the control of knee rotation and translation, during simulated pivot-shift scenarios, to these four surgery settings. Methods: A computer model was used to simulate 625 lateral extra-articular reconstructions based upon five different variations of each of the following parameters: femoral and tibial attachment sites, knee flexion angle and graft tension at the time of fixation. For each simulated surgery, the lateral extra-articular reconstruction external rotation moment at the knee joint center was computed during simulated pivot-shift scenarios. The sensitivity of the control of knee rotation and translation to a given surgery setting was assessed by calculating the coefficient of variation of the lateral extra-articular reconstruction external rotation moment. Findings: Graft tension had minimal influence on the control of knee rotation and translation with less than 2.4% of variation across the scenarios tested. Control of knee rotation and translation was the least affected by the femoral attachment site if the knee was close to full extension at the time of graft fixation. The choice of the tibial attachment site was crucial when the femoral fixation was proximal and posterior to the femoral epicondyle since 15 to 67% of variation was observed in the control of knee rotation and translation. Interpretation: Femoral and tibial attachment sites as well as knee flexion angle at the time of fixation should be considered by surgeons when performing lateral extra-articular reconstruction. Variation in graft tension between the ranges 20-40 N has minimal influence on the control of knee rotation and translation.

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“…Despite ongoing controversy in the literature, multiple biomechanical studies have demonstrated that the ALL plays a role in anterolateral rotatory instability related to the pivot-shift phenomenon [24,26,32,33,37,40,44,45,47,49]. Segond fractures are sometimes seen in periarticular knee fractures.…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment for Avulsion Fractures of the Anterolateral Ligament Associated with Periarticular Fractures of the Knee

Wei

Wang

et al. 2020

Preprint

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Background: To confirm the existence of the ALL and evaluate the clinical outcomes of surgical management for avulsion fractures involving its insertion when associated with periarticular knee fractures.Methods: Twenty-three patients (16 males and 7 females) with avulsion fractures of the ALL associated with periarticular knee fractures were fixed with a spider plate, cannulated screw, or suture anchor. Eight patients were diagnosed with distal femoral fracture, 10 with tibial plateau fracture, and 5 with tibial eminence avulsion fracture. All patients underwent X-rays at follow-up. Clinical and functional outcomes were assessed with the pivot-shift test, objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale.Results: The ALL was found and identified as a distinct ligamentous structure in all patients. Pre-Segond repair, patients had significantly more instability as determined by pivot-shift test than seen postoperatively (P < .0001). At final follow-up, the mean subjective IKDC score was 83.2±10.3. Fourteen patients were graded A, 6 were graded B, and 3 was graded C on the IKDC objective score. The mean Lysholm score was 85.4 ± 12.2. The mean Tegner score was 7.5 ± 1.2.Conclusion: This study confirmed that the ALL is a distinct structure in the anterolateral portion of the knee. The fixation for the avulsion fracture of the ALL associated with periarticular knee fractures can be an effective procedure without specific complications. Longer term and comparative follow-up studies are necessary to confirm the effects.

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Is an Anterolateral Ligament Reconstruction Required in ACL-Reconstructed Knees With Associated Injury to the Anterolateral Structures? A Robotic Analysis of Rotational Knee Stability

Cited by 105 publications

References 53 publications

The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting

The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting

Technical considerations in lateral extra-articular reconstruction coupled with anterior cruciate ligament reconstruction: A simulation study evaluating the influence of surgical parameters on control of knee stability

Surgical Treatment for Avulsion Fractures of the Anterolateral Ligament Associated with Periarticular Fractures of the Knee

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